Healthcare Provider Details

I. General information

NPI: 1851751150
Provider Name (Legal Business Name): THOMAS VERALDI, DMD RESIDENCY AND HOSPITAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 W ALEXANDRINE ST 3RD FLR
DETROIT MI
48201-2015
US

IV. Provider business mailing address

7310 WOODWARD AVE STE 400
DETROIT MI
48202-3165
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-2895
  • Fax: 313-263-4332
Mailing address:
  • Phone: 313-833-2895
  • Fax: 313-263-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901021771
License Number StateMI

VIII. Authorized Official

Name: DR. THOMAS VERALDI
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 313-833-2895